The US health insurance industry is in the midst of a tectonic shift. Since federal legislation mandated health coverage for all US citizens, health insurers have been pivoting away from pure B2B models to reinvent themselves as B2C services – and they’ve been responding to the demands of a new target group: consumers who purchase their own health insurance.

Earlier this year, we published a blog post detailing the channels customers use when purchasing health insurance. But mapping customers’ physical interactions with a company is only part of the story – understanding their emotional evolution is just as important. According to Forrester’s Consumer Technographics® data, a mere 50% of consumers who purchase their own health insurance feel that the brand puts them first; others believe health insurers do what’s best for their own bottom line at the expense of customers. The former are not only emotionally satisfied, they are also loyal to their current health insurer and willing to spend on additional products and services:

If you’ve been following our blog, you’ll know that the Data Insights team here at Forrester has been tracking the evolution of US healthcare reform over the past three years and its implications in terms of consumer behavior, attitudes, and expectations. Our study began in July 2012, when we advised health insurance companies how to prepare for the flood of new customers entering the market. Two years later, my colleague Gina Fleming extended this analysis into Forrester’s Healthcare Segmentation, which provides a refined understanding of key customer profiles. Now, with our 2015 Consumer Technographics® Healthcare Survey just back from field, we can complement our understanding of the US consumer health insurance market with another layer of insight: the member’s journey to purchasing health insurance:

As the healthcare industry depends increasingly on software to drive the change to value-based care from transaction-based compensation, the future of global healthcare is increasingly bound to the technology that will deliver:

Integration solutions that will allow stakeholders to share information about populations and individuals across the ecosystem.

Cloud-based solutions that will allow services to reach scale without the need for the contemporary care system or health insurance vendor to grow infrastructure.

Branded medical services, such as oncology advice engines that allow a regional cancer specialist to deliver a better quality of care because she will have, for example, access to the most advanced protocols for her patients via smart software powered by companies such as IBM but with the built-in expertise of our great medical centers such as Memorial Sloan Kettering Cancer Center.

The Rise of consumer health repositories will work against info sharing in the eco-system - crossing the divide between protected data owned by covered entities, under various global privacy laws such as HIPAA, and consumer controled data subject to the corporate policy of various business entites such as Microsoft, Apple, Samsung, and others will remain dificualt and cumbersome.

If the healthcare industry exhibited symptoms of dysfunction, the US government administered a wave of treatment in the form of the Patient Protection and Affordable Care Act. October 2013 marked the opening of online insurance marketplaces, and set the stage for the act's requirement that most US residents have health insurance coverage. As a result, the industry has witnessed cessations and regenerations, and the pulse of consumer sentiment has fluctuated. Now, one year on, we’re due for a checkup.

At a macro level, US online consumers’ perspectives on healthcare reform today are largely consistent with those immediately preceding open enrollment under the federal law: Individuals continue to be skeptical of policy changes. However, at a micro level, subtle yet fundamental shifts in the consumer mindset signal a gradual evolution in perceptions of healthcare.

Our Technographics 360 research approach, which synthesizes Forrester’s ConsumerVoices Market Research Online Community insight and aggregated social listening data, shows that the conversation about healthcare has shifted from politics to experience -- and, in particular, to a focus on cost:

The age of the customer coupled with the onset of the Patient Protection and Affordable Care Act (a.k.a. "Obamacare") means that many new customers will enter the US health insurance market. One outcome of the legislation is an opportunity for health insurance marketers to acquire new customers and engage existing customers — and Forrester wants to help them seize this moment. As such, we have created a consumer healthcare segmentation to identify unique groups of US consumers as well as their healthcare needs and attitudes to help health insurance marketers target new customers, engage existing customers, and innovate exciting healthcare tools and programs.

Our report, “Introducing Forrester’s Consumer Healthcare Segmentation,” explains each segment and how to attract or engage them. The segmentation includes both insured and uninsured consumers, representing the entire US online adult population. The graphic below shows each of the segments and their relative size.

Some highlights from the report, which is based on a survey of more than 4,500 US online consumers:

Fitness Trackers are young and love to use wearable devices; in fact, everyone in this segment uses one. The majority agree that that their health and wellness are priorities for them and they try to eat a healthy diet, but close to half believe that they are so healthy that they don’t need health insurance.

Anybody out there who doesn't have a mobile device, raise your hand...just what I thought.

The explosion of mobile phones and apps in the everyday lives of consumers--and agents--is powering big changes in the business of insurance. Heightened customer expectations are getting formed by the changing mobile landscape; new generations of customers; new competitors, and the ferocious pace of mobile tech-enabled innovation that is radically reshaping how customers become informed, purchase, and get service.

In our new report, the first of Forrester's Mobile Insurance Playbook, we examine how mobile forces are driving customer expectations and how customer demands are going to influence new insurance business models.

Consider that:

Consumers are living La Vida Mobile. Mobile is a pervasive element in the daily lives of insurance customers. With more mobile devices available within easy reach, US consumers are tapping into this ready convenience to research, buy, and service their financial needs, including insurance. And how about those Millennial insurance customers? More than one in four told us that they use mobile as their main personal financial channel.

Agents are becoming proficient mobile tool users. The tablet form factor looks almost purpose-built for the needs of agents. From their hi-def displays to fast boot-up and super portability, agents are ardent tablet-ers, and half the agents in an informal survey at the end of last year cited mobile as one of their leading business initiatives.

The Supreme Court decision upholding virtually all of the Patient Protection and Affordable Care Act (AKA “Obamacare”) shifted a balance for customer experience professionals in the healthcare industry. Now they — and the executives they report up to — know that it’s more risky to do nothing than to respond by taking action.

Keeping in mind that “the healthcare industry” is really three industries, here are some of the most important actions that healthcare organizations will need to take.

Health Insurance Providers (Payers)

As we point out in our upcoming book, Outside In, the health insurance industry has owned the cellar of our Customer Experience Index (CXi) since we began that study five years ago. The main reason for its dismal performance is that the CXi is a consumer study, and for health insurance providers, the customer has not been a consumer but a business — or more accurately, a person at a business, like a benefits manager.

The result was that payers didn’t need to focus much on the end users of their products — consumers — so most of them didn’t. But starting in 2014, a greater percentage of their business will come from consumers. That will drive health insurance providers to better understand consumers so they can attract and retain the healthiest ones, who are the most profitable. Payers will also want to get consumers to change their behavior as a way to keep costs down. For example, they’ll want them to opt for generic drugs and to take better care of themselves. But none of that will happen unless the health insurers build a trusting relationship by providing a far better experience than they have to date.

I'm excited that I'll be spending time with Forrester clients next week at Forrester’s Customer Experience Forum 2012 East. On the second day of the forum (Wednesday, June 27th), there are two industry presentations of particular interest to healthcare industry executives: